Complain Handling

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complain handling


Complaint handling in health services A short day seminar for managers and cliniciansA An rv nE vi ic ce du es uc s ca at ti io on nP Ed ac ck ka ag ge ef Pa or rH ea al lt th fo hS er He Se T TR RA AI IN NE ER R S SR ES SO OU UR RC CE ES S RE _ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ _ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ ContentsHalf Day Seminar Presentation Flow Chart of Complaints Management Principles of Open Disclosure Letter of Complaint References & Resources Trainers Notes Half Day Seminar Annotated Letter of Complaint for Trainer 2 48 49 50 53 55 69



The Health Services Review Council of Victoriagratefully acknowledges the work of Amanda Adrian and Susan Bunting and the funding from the Department of Human Services and the Victorian Managed Insurance Authority in the preparation of this training package.


Session Outline1. 2. 3. 4. 5. 6.

Complaints & why people complain Complaints in context Seven Guiding Principles A Systematic Approach to Complaints Using the Seriousness Assessment Matrix (SAM) Interacting and Communicating Break Case Study



1. Complaints and why people complain


Why do people complain?The person did not receive: { sufficient or correct information { safe health care { respect { expected outcome { quality communication { timely care


What do they want ?information to be taken seriously better care an apology occasionally, compensation

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2. Complaints in Context



Why have a complaints system?We believe that dealing promptly and effectively with complaints has considerable benefits for health organisations, including better quality health care, reduced likelihood of litigation, and substantial savings in the direct and indirect costs arising from adverse incidents, complaints and claims. Health Services Review Council of Victoria 20058

Complaints are integral to a quality service{ {



Complaints are inevitable Having a system takes the stress out of their management Helps health system to learn from mistakes Identifies gaps in current services



{ {

Provides trend data that is useful for quality improvement Recognises right of health consumers to complain Restores trust Provides a mechanism for consumer input into quality improvement


More on quality ...Increased patient involvement [including access to complaints mechanisms], a result of various sociopolitical changes, is an important part of quality improvement since it has been associated with improved health outcomes and enables doctors to be more accountable to the public.SAY and THOMPSON BMJ 2003;327:542-545 (6 September)


Complaints promote ethical care{ {

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Autonomy : The process is consumer focused and gives the consumer input into health outcomes. Nonmaleficence (doing no harm): Positively reinforces consumer confidence in the system through a publicised systematic complaints mechanism which encourages confidence and participation in care. Beneficence( acting for the good): Lessons learnt when handling complaints serve to improve clinical care. Justice: Assessing complaints systematically ensures fairness in their handling.11

See Beauchamp T. & Childress J. Principles of Biomedical Ethics ( 5th Edition) New York 2001 OUP

3. The Seven Guiding Principles


Seven guiding principlesQuality Improvement { Open Disclosure more on this a little later { Commitment { Accessibility{ { {


Responsiveness Transparency and Accountability Privacy and Confidentiality

See Audit Tool in the Guide to Complaint Handling p 32


QI elements influencing complaints handling{ { { { {

A system approach to quality An emphasis on patient safety Consumer focus & participation Corporate & clinical governance Legal & policy frameworkSee ACHS Accreditation Standards EQuIP 3 and 4


Organisational Foundations

Policies Promotion Staff Training and Support Complaints Manager Recording Systems Tracking Data collection Reporting15

Key considerations in complaint handling and response{ {

{ { { { {

All staff participate in complaint handling Address frontline complaints as soon as possible Assess complaints using SAM (more later) Treat all parties with consideration & respect Address each issue Give feedback to all parties Learn from new insights16

Possible outcomes from a complaint{

Information & apology provided Policy/protocol change Staff or consumer education New service to be provided


Monitor trend and/or conduct clinical audit Reference to Quality or other Committee Systems review







About Open Disclosure {



The National Standard on Open Disclosure has yet to be endorsed by the Australian Health Ministers and continues to be trialled around Australia. Open disclosure is about clear communication between clinician and patient. It is the ethical and legal responsibility of a treating clinician to inform a patient of matters which may have an adverse outcome on the patient's health. Exceptions to this are only legitimate when it can be demonstrated that such information may do the patient harm. Handout 3 : Principles of Open Disclosure18

How can it be done?1. Expression of regret or apology (does not create liability) 2. Known clinical facts (without opinion or speculation) 3. Seeking patient's questions/concerns 4. Discussion of ongoingcare19

5. Informing of side effects to look out for 6. Informing what happens next (investigation of the adverse event and feedback) 7. Contact details in case of further concerns or questionsSource: OPEN DISCLOSURE EDUCATION AND ORGANISATIONAL SUPPORT PACKAGE vww.safefty and

4. A systematic approach to complaints


Health Services Review Council (2005) Guide to Complaint Handling in Health Care Services, p 23. Handout 4

Point of Service Complaints


What is NOT a point of service complaint?


5. Assessment: Using the Seriousness Assessment Matrix (SAM)


Using SAM

Health Services Review Council (2005) Guide to Complaint Handling in Health Care Services, p 47.25

Health Services Review Council (2005) Guide to Complaint Handling in Health Care Services, p 48.


Health Services Review Council (2005) Guide to Complaint Handling in Health Care Services, p 48.


Health Services Review Council (2005) Guide to Complaint Handling in Health Care Services, p 49.


6. Interacting and Communicating


What to do when receiving a complaint{ {




Introduce yourself. Listen carefully to what the consumer is saying. Try to see things from their point of view. Clarify anything youre not sure about. Deal with the issue on the spot if possible.




Write down the details on the organisations complaint/feedback form. Thank the person for their feedback. Tell them what will happen next.


What NOT to do when receiving a complaint

Be defensive or take it personally. { Blame others. { Make assumptions without checking your facts. { Argue with the consumer. { Be dismissive it takes courage to complain.{31

Difficult situations{




Remain polite and respectful. Focus on the issue at hand, rather than the personalities. Take time to understand what the problem is there may be an easy solution. Be prepared to listen, without getting caught up in emotions the person wants to be heard

{ {


Be patient. Provide information or an expression of regret as appropriate. Ask another staff member for help if necessary.




7. Case study


Setting the Scene{

You are ED Director - Jeribombera Health Service. In your in-tray is a letter of complaint from Ms Linda Murray - forwarded via the CEOs office. You read the complaint & enter details into the complaint register. Now its time to examine the complaint prior to discussions with relevant staff. Handout 5




The Letter of Complaint

From Ms Linda Murray



What are your initial responses to this complaint? What might be underlying reasons Ms Murray has made this complaint? Are there other issues not identified? Do you agree with the issues identified? Handling factors - considerations relating to each party.37





Issues by partyLINDA MURRAY Handling factors{ { { {

Explain complaints process including review options May be angry and emotional critical to display compassion and understanding Role of Darren (husband) in process to be clarified Unsuccessful point of service complaint resolution hence letter to CEO. Relationship with Director of ED coloured by that experience38

Issues by partyDOCTOR 1 Context senior resident - first rural placement - little paediatric experience. Third shift at hospital, weekend & did not know other staff well, including immediate supervisor. Had not completed orientation Handling Factors { Will need complaints process clearly explained { Requires support person39

Issues by partyDOCTOR 1 Issues { Adequacy of introduction to Ms Murray { Understanding of & response to views, concerns & opinions expressed by